In the movie "Field of Dreams," Kevin Costner's character hears a voice that says, "If you build it, they will come." In response, he builds a baseball park in the middle of an Iowa cornfield. In California, we witnessed a similar situation—in 2001 we created a program for students with Asperger's syndrome with an initial enrollment of seven, and today the program serves 106.
The program was not started in the middle of a cornfield, of course, but in the William S. Hart Union High School District (WSHUHSD), a secondary district fed by four elementary districts in the Santa Clarita Valley in northern Los Angeles County.
This award-winning program provides educational support for students with Asperger's syndrome and high-functioning autism (HFA) from grade seven through community college.
The program, recognized by the California Speech-Language-Hearing Association in 2005 as Program of the Year, was conceived as a cost-saving measure. In early 2000, a number of WSHUHSD students with Asperger's syndrome and autism were being placed in nonpublic school (NPS) because the district had no program that could meet their educational needs. With autism diagnoses on the rise, the need to control the cost of NPS placement was evident.
In addition to saving money, the program also allows students to attend school in their own communities on secondary campuses with a full range of academic and extracurricular opportunities, and allows us to monitor student progress closely and make adjustments as needed.
I was hired in 2002 to help with program development because of my background in pragmatics, but I also have a personal interest—my son, then in sixth grade, was diagnosed with Asperger's syndrome in 2000.
Our students' individualized education programs (IEPs) call for self-contained placements; we have four classes on two junior high school campuses and seven classes in two senior high campuses. Students are integrated into general education classes as appropriate. The inaugural group of students are in their second year at our local community college.
Students identified as program candidates frequently have a history of school-related social and academic difficulties. Some have not received appropriate services because they are undiagnosed or misdiagnosed. A school psychologist and I screen candidates to identify and place students, using a number of tools and methods—behavioral observations, communication with staff, review of records, and administration of the Autism Diagnostic Observation Schedule (2001 Western Psychological Services, 2001).
Once placed, most students receive academic instruction in self-contained classrooms, and are integrated for electives. When a student is able to handle the demands of a mainstream academic course, the student joins the regular class—usually a subject in which the student is proficient in order to provide a successful experience.
The program for students with Asperger's is a work in progress, with development and expansion based upon the needs of our students and their families. Some program components, however, are fundamental:
- Classrooms are arranged to provide continuity in visual schedules, classroom rules, a positive behavioral support system, and other components.
- Consistency within the classroom environment is maintained for students matriculating from one campus to another.
- Specialized physical education program is designed with the unique needs of the student with Asperger's syndrome.
- Adapted physical education or occupational therapy is available for students who need those services.
The entire staff receives intensive training to build skills and knowledge about Asperger's in adolescence, including the neurology of autism spectrum disorders (ASD), characteristics of students with Asperger's, behavioral issues, social skills, issues of co-morbidity, and executive function. Ongoing training includes monthly team meetings, where staff members offer support, share information, present student case studies, and receive new information about ASD.
The parent support group is a beneficial and important part of the program. Another vital component is "Yes I Can," a social inclusion program developed at the University of Minnesota. This program is designed to promote the social inclusion of students with disabilities by developing their social skills and empowering them to develop and maintain friendships, while strengthening the leadership skills of regular education students who volunteer to participate.
The Role of the SLP
It is important to have a dedicated SLP for the program to provide continuity and consistency for students and families. I learned that my responsibilities would expand greatly: I serve as a liaison between the district and community agencies; collaborate with outpatient mental health services; train "Yes I Can" mentors; assist with support staff training; and collaborate with school psychologists to screen incoming seventh-grade students.
My background in pragmatics was helpful, but I soon realized that treatment for the students required social-cognitive training as well. Consequently, we chose to implement an in-class or push-in service delivery model that infuses and reinforces social skills training throughout the school day. Because students with Asperger's have social deficits, providing services using an in-class model helped to provide more opportunities for students to practice social and communication skills in a more natural context. This model also helps students whose IEPs do not include language and speech services. While "pull-out" services remain the most common type of service delivery, ASHA (2005) suggests that the inclusion of communication partners is beneficial to minimize social isolation and enhance communication competence. Additionally, this model works best when students on the autism spectrum are served within an integrated or inclusive setting (ASHA, 2005).
In the push-in service delivery model, social skills are infused throughout the school day. There are also many opportunities throughout the day to capture and reinforce teachable moments. In addition, students learn from one another—for example, one student with Asperger's who is able to self-regulate and avoid blurting out information may model that behavior for a student who has difficulty in that area. Because students with Asperger's typically do not generalize effectively (Bellini, 2007; Simpson, 1998), my role is to help them develop the skills they need to be competent communicators across many social settings and with a variety of communication partners.
It is also critical for the SLP to understand the core deficits that affect the daily functioning of students with Asperger's: impairment in social interaction, limited/restricted interests, and communication impairment characterized by decreased engagement, joint attention, and reciprocity. The SLP should also have a thorough knowledge of theory of mind (ToM) to understand the core deficits as they relate to the student with Asperger's and to form strategies to help remediate the deficits. As an example, Michelle Garcia Winner—drawing upon the ToM model—uses the term "social thinking," the ability to think about others and realize that they have thoughts, feelings, and beliefs about you that may be separate from your own.
It is also necessary to understand the unique learning style of students with Asperger's, so that we understand why we are teaching a particular concept and how best to present the information to help maximize the students' acquisition of information. It is also helpful to assess students' strengths and weaknesses within the pragmatic and social cognitive domains using available social skills rating scales.
The question remains: where do you start intervention? My conceptual model includes a hierarchy of social skills:
- Pre-requisite skills
- Theory of mind
- Making a positive impression
- Becoming aware of others and themselves
- Entry-level skills
- Thinking in questions
- Finding common interests
- Having conversations
- More advanced skills
- Joining in conversations
- Dealing with sarcasm/teasing
Student Role Models
The success of our program is due in part to the general education students who participate in the "Yes I Can!" program. These students are recommended as peer mentors and act as social role models for students with Asperger's syndrome. During a class discussion, the peer mentors suggested that they were capable of teaching—not just helping with—the social skill lessons. The peer mentors coined the term Social Strategy Teams, and the model shifted from direct instruction by an adult to a student-led lesson, with direct supervision from the SLP, teacher, and instructional assistants. The content for lessons included a variety of commercial resources and information from experts in the field of autism.
The students selected some topics they were most interested in; for example, slang and dating. Mentors were given strategies to teach the desired social skill, including role-playing, problem-solving, class discussion, and videotaping. The result was greater interaction among our students with Asperger's syndrome and their peer mentors, many of whom made plans to socialize during lunch and off-campus.
As the program evolved and the students moved out of the self-contained classroom and onto the campus, the students with Asperger's syndrome and peer mentors began interacting much more often as they spread out under trees, on benches, and at other natural social locations.
From the students' interactive journals of their social exchanges, we found that the longer the students were in the program, the better they were able to describe their social experiences with insight and depth not previously observed. Teachers review the entries to assess how well students are able to generalize their skills and to add comments to help the students with future social interactions.
I meet individually with students to determine how they think they are progressing toward their goals. Frequently, students will suggest something that they would like to work on. One student, for example, said that he knows he sometimes stands too close to his communication partners and would like to work on being more aware of his "personal space" during conversations. Meeting with students helps them develop the ability to gain insight about themselves and to self-advocate, skills they need for post-secondary transition.
As a result of the paucity of data on efficacy of social skills training (Bellini, 2007; Harpur, 2006), I am developing a prototype for a social skills rating scale that follows our program's hierarchy of skills. This observational scale will be completed at the beginning and end of an academic year, and will help determine growth in specific skill areas.
As SLPs, it is our role to help open the door of possibility for these young people so that they might realize their full potential.